What is the treatment for viral stomatitis?

Treatment of Viral Stomatitis

The treatment of viral stomatitis should focus on topical anesthetics, chlorhexidine rinse, and protective gels for pain control, with consideration of antiviral medications for herpetic stomatitis. 1

Diagnosis and Classification

Viral stomatitis presents with characteristic lesions depending on the causative virus:

• Herpetic stomatitis: Spherical clustered vesicles on gingival and adjacent mucosa that rupture to form painful ulcers 2
• Aphthous ulcers: Can be minor (<1cm, healing in 7-14 days), major, or herpetiform 1

Treatment Approach

Topical Treatments (First-line)

• Pain management:

  • Benzocaine-containing topical anesthetics for effective pain relief 1
  • Non-alcoholic analgesic rinses such as Difflam Oral Rinse (benzydamine hydrochloride 0.15%) before eating or brushing teeth 1
  • Avoid alcohol-based mouth rinses as they can irritate inflamed tissues 1

• Infection prevention and healing promotion:

  • Chlorhexidine gluconate 0.2% rinse twice daily to prevent secondary infection 1
  • Protective gels (Gengigel, Gelclair) to form a barrier over ulcers 1
  • Sucralfate suspension for larger ulcers or those present for more than one week 1

Antiviral Therapy (For herpetic stomatitis)

• Early treatment with antiviral medications can modify disease course by reducing symptoms and potentially reducing recurrences 2
• Topical antivirals such as acyclovir or docosanol creams can be applied at the first sign of outbreak 1
• Systemic acyclovir has shown some evidence of effectiveness in improving healing of oral lesions and reducing symptom duration 3

Supportive Care

• Maintain adequate hydration and electrolyte balance 2, 1
• Use topical corticosteroids for large ulcers present for more than one week 1
• Oral analgesics for pain management 1

Lifestyle Modifications

• Oral hygiene:

  • Use soft toothbrush and mild fluoride-containing toothpaste 1
  • Replace toothbrush monthly to prevent bacterial accumulation 1
  • Daily inspection of oral mucosa for abnormalities 1

• Diet modifications:

  • Eat soft, moist, non-irritating food that is easy to chew and swallow 4, 1
  • Avoid acidic, spicy, salty, rough/coarse food 4, 1
  • Drink plenty of water to maintain hydration 4, 1
  • Use lip balm for dry lips 4, 1

Special Considerations

• For denture wearers: Remove dentures at night, clean thoroughly daily, and consider adhesives to improve fit 1
• If ulcers persist beyond 2 weeks despite treatment, consider biopsy to rule out malignancy 1
• Evaluate for underlying conditions if no response after 2 weeks (nutritional deficiencies, gastrointestinal disorders, immune disorders, HIV infection) 1
• Most viral stomatitis cases are self-limiting, but dehydration is a common complication that may require hospitalization 5

Treatment Based on Severity

• Minor cases: Topical anesthetics, chlorhexidine rinse, and protective gels as needed 1
• Moderate to severe cases: Add topical corticosteroids and consider sucralfate suspension 1
• Severe cases with dehydration: May require hospitalization for fluid replacement 5

Remember that most infectious viral stomatitis is self-limiting, but proper management can significantly reduce discomfort and prevent complications 6, 5.